Christine Jordan Sexton
The Senate Ethics and Elections Committee voted 8-1 to approve Liz Dudek‘s appointment as head of the state Agency for Health Care Administration but only after she answered more than an hour’s worth of questions regarding Low Income Pool funding, Medicaid expansion and how negotiations are evolving with the federal Centers for Medicare and Medicaid Services.
Senators asked pointed questions and Dudek — a longtime state health care planner held in high regard by the Florida Legislature — gave senators the answers they sought.
She acknowledged there is a chance that Florida could get no supplemental Medicaid funding — known as LIP — though she couldn’t tell the Senate how likely that would be.
She acknowledged that the agency and the governor’s office do not have a “plan B” if the federal government cuts off the LIP funding, now set at $2.1 billion, more than $1 billion of it federal money.
When Sen. Joe Negron asked what amount Florida could expect to receive in LIP funding Dudek hesitated. “We know what number we believe is correct,” she said, adding that at one point the federal government countered Florida’s request for $2.1 billion with “half of that amount.”
Negron pressed for a dollar figure with a follow-up question, and Dudek replied: “Unfortunately, given that I can’t guarantee what they would approve, I don’t know if I can give you a figure. I wish I could.”
She also told the Senate she didn’t think a trip to Baltimore by Sens. Rene Garcia and Garrett Richter interfered with negotiations between the state and federal government. The House of Representatives and Gov. Rick Scott‘s office have suggested repeatedly that the senators’ unexpected trip to Baltimore may have derailed negotiations.
A growing controversy about the expiration of the LIP program involves when the agency began to prepare for the impending loss of federal dollars and what it did to prepare.
Those series of questions came from former Senate President Don Gaetz.
“We knew a year ago that LIP was ending or being radically changed. We knew a year ago it was a multibillion impact on our budget. When we dealt with issues like this in the past we submitted a 235-page proposal to the federal government,” Gaetz said. “Did we submit a formal proposal with narrative and explanations to the government anytime before late February or early March of this year?”
Dudek said the agency submitted nothing, but that it was advised by the federal government it didn’t need to because CMS would be “flexible” and work with the state.
Dudek said the state had submitted three Low Income Pool proposals to the federal government in early March. Gaetz then interrupted her testimony noting that in previous testimony, Deputy Medicaid Director Justin Senior described the documents as “scenarios.”
Gaetz said that to him the documents appeared to be “spreadsheets, vague concepts.”
As Gaetz continued to press, Dudek said that the agency submitted a formal proposal to CMS on Wednesday and that it was the modified LIP proposal compiled by the Florida Senate.
Gaetz then countered: “Well, I’m glad the Senate was not the impediment then. Apparently, we were the only life raft available.”
Gaetz also questioned Dudek whether the governor’s office or agency had debated the merits of submitting a request for a 1332 innovation waiver, named after the section of the federal health care law — known as Obamacare — that creates them. Essentially the “innovation waivers” are block grants that would allow the state freedom from the federal health care law. Dudek said there had been no discussions about the waivers.
Former AHCA Secretary Alan Levine told Florida Politics at the beginning of the Legislative Session that the state should apply for an innovation waiver.
Gaetz asked Dudek whether the governor supports the Senate plan, and she replied, “The governor supports our submission of the amendment which is the Senate LIP plan. Yes.”
When asked whether she’s satisfied with the approach Florida has taken to renegotiating the LIP dollars, Dudek acknowledged she has been “disappointed” but quickly added that the federal government is “100 percent in control.”
When asked whether it was ever the governor or AHCA’s plan to not go forward with LIP dollars, Dudek said, “It has never been within our realm of thought that we wouldn’t continue moving forward with the LIP.”
Throughout her testimony Dudek maintained — as does her boss — that Medicaid expansion and the continuation of the Low Income Pool dollars are separate issues and not linked. Dudek said she did not realize the two were linked until the Department of Health and Human Services sent the letter to AHCA on April 14.
Unlike Department of Health Secretary John Armstrong — who awkwardly avoided answering questions about Medicaid expansion and whether he supported it — Dudek artfully responded to questions when they came her way. Armstrong’s confirmation process has been temporarily deferred by the Senate and has not been taken up again.
She said no one has complained to her agency about lack of access to health care when she was asked whether accepting federal Medicaid dollars would improve Floridians’ access to health.
Dudek did offer that she doesn’t think the Senate’s proposed plan to expand Medicaid access — called FHIX — would pass muster because of the requirements that many of the Republicans in the Senate are most proud, such as a work requirement and co-payments.
